13.04.05 Clinic notes

Thyroid cancer

    • Types

      • Papillary

      • Folicular

      • Anaplasti (Dead in 6 months)

      • Medullary (Different to the other three)

        • Comes from C cells (different origin)

        • Treat with wide excision (big scar)

        • Follow with external beam radiotherapy

        • Produce calcitonin

    • Check-ups

      • TSH levels

        • In order to check suppression by exogenous thyroxine

        • Make sure there's no TSH around to stimulate remaining cells

      • Thyroglobulin

        • Produced by remaining cancerous thyroid cells

Macular degeneration

    • Risk factors

      • FHx, Smoking, Age, (HTN)

    • Types

      • Dry

        • Common, Slow, Untreatable

      • Wet

        • Rare, Fast decline, Treatable in early stages

        • Can use anti-VEGF agents, injected into eye (pricey)

RA

    • Atlantoaxial subluxation

    • Swan-neck vs boutonniere deformity

    • Check ESR as well as CRP as one or both my rise

    • Inflammation makes you tired

    • Associated symptoms

      • Sicca

      • Sun rash

      • Rash

      • Mouth ulcers

      • Raynauds

      • Migraine

      • GI

    • Smokers do worse

    • Hydroxychloroquine

      • Safe in pregnancy

      • Slow offset

      • Ophthalmological complications

        • Binds melatin => Retinopathy

    • 50% can't work within 5 years

Notes

    • Acetazolamide side effects

      • Flatulence, dry skin, taste changes, "fizzing feeling"

    • Tinnitus:

      • Prevalence: 30% at some point, 10% permanently

      • CBT, Retraining therapy, Mindful meditation, Relaxation therapy (? effect above just the counselling)

    • White noise desensitisation in hyperacusis => Decreased central gain (6-8 dB)

    • Steroids raise IOP

    • Causes of straight-line distortion

      • Lens

      • Cornea

      • Retina

        • RPE detachment

        • Haemorrhage

        • Scarring

  • Xalatan (Latanoprost)

      • Used for controlling the progression of glaucoma or ocular hypertension by reducing intraocular pressure

      • Prostaglandin F2α analogue

      • Works by increasing the outflow of aqueous fluid from the eyes, through the uvealsclearal tract

    • Sarcoidosis

      • Check serum ACE levels

      • Non-caseating granulomas

      • Derranged calcium

    • NSAIDs block spine fusion post-surgery

    • Tibialis anterior (dorsiflexion) for L5 function after spinal injury

    • Proximal muscle weakness: Steroids, Low Vit. D

    • Tapentadol